INTRODUCTION:

During postnatal period there is a chance to increase the risk of development of serious mood disorder. This type of depression during postnatal period has been classified into 3 categories in ascending level of severity condition of mother- maternity blues, postpartum depression and psychotic depression.¹

Postpartum depression is a combination of physical, behavioural and emotional changes in some women within 4 weeks of delivery. PPD is based not only length of time taken between delivery and onset, but also severity of the depression. During the pregnancy estrogen and progesterone hormone increased excessively. After 3 days of delivery hormones levels drop back to pre-pregnant stage. This type of changes increased the risk of postpartum depression. Most of the mothers have face “baby blues” after giving birth.

In this 1 out of 10 cases will develop severe type of depression later stage. It can be treated with counselling and medication.²

Post-partum blues incidence rate is 300-750 per 1000 cases globally. Post-partum psychosis has global prevalence from 0.89 to 2.6 per 1000 births and those mothers requires to hospitalization.³ 100-150 per 1000 births are globally prevalence rate of postpartum depression.⁴

In a study shows that, following factors are responsible for post-partum depression: Age less than 20 years or over 30 years, education qualification less than class 5, thoughts of aborting pregnancy, Unhappy married life, physical abuse during pregnancy and after childbirth, alcoholic husband, girl child delivered, preference for a boy child, low birth weight and family history of depression.⁵

In India around 8% of the primigravida mothers were affecting postpartum depression. In Karnataka prevalence rate of postpartum depression ranges from 10-15% and screening rates of depressive symptoms as high as 35%.⁶

Mothers with PPD may be experiencing lack of interest in their baby, loss of pleasure, lack of concern for themselves, negative feelings towards their baby, changes in appetite or weight, worrying about hurting their baby, lack of energy and motivation, feelings of worthlessness and guilt, sleeping more or less than usual and recurrent thoughts of death or suicide.⁷The left and untreated PPD cases can last for a significant length of time, even up to a year or more.⁸

Postpartum depression is a commonest and serious type of mental health problem. It is associated with maternal suffering and numerous negative consequences for offspring. The first 6 months after child birth may represent a high-risk time for depression. It is estimated that prevalence range from 13% to 19%.⁹The obstetrician and pediatrician can play important roles in screening for and treating PPD. Treatment options includes antidepressant medication and psychotherapy.¹⁰

OBJECTIVES:

1. To assess the pre-test and post-test knowledge regarding prevention of post-partum depression among care givers of primigravida mothers.

2. To evaluate the effectiveness of STP regarding prevention of postpartum depression among care givers of primigravida mothers.

RESEARCH METHODOLOGY:

Research Approach:

For this study quantitative research approach was taken

Research Design:

Keeping view of objectives of the study, the research design selected for the study One group pre-test and post-test design.

Population:

The study population refers to primigravida mothers in Postnatal ward, Kalinga Institute of Medical Sciences.

Sample and Sample Size:

The sample for the study will be comprised of 60 care givers of primigravida mothers.

Study Setting:

Postnatal ward, Kalinga Institute of Medical Sciences.

Method of Data Collection:

Questioning method used.

Sampling Technique:

Convenience sampling technique used for this study.

Selection Criteria:

Inclusion Criteria:

Care givers of primigravida mothers who:

· Read and understand Odia.

· Willing to participate in the study.

· Available during data collection.

Exclusion Criteria:

Care givers ofprimigravida mothers who:

· Previously attended any class regarding PPD.

· Care givers who did not give consent.

· Did not have any family members staying with primigravida mothers.

Tools of Data Collection:

Investigator had developed the tool (Demographic data and Self Structured Knowledge Questionnaire regarding prevention of post-partum depression) for data collection and validated by experts and found to be valid after some modification. Tool was divided into two section, Section-I which has seven items that was constructed to obtain demographic data of the sample i.e. Age, Religion, Educational status, Mode of delivery, Type of family, Gender of baby, Monthly family income. Section-II which was 20 items that constructed to obtain knowledge level post-partum depression. Each question contains 1 mark.

Scoring Criteria of Tools:

Adequate Knowledge: ≥ 75% (15 marks or above)

Moderate Knowledge: 51%-75% (11 marks to 15 marks)

Inadequate knowledge:

≤ 50% (Less than 10 marks)

Data Collection Procedure:

Data was collected in third week of March 2017 over a period of seven days. Formal permission was obtained from the concerned authorities. Convenience sampling technique was used for selection of sample. Sample selected based on inclusion and exclusion criteria which decided whom to include in the study. The purpose of the study was explained. The investigator assured confidentiality of the response. Written consent was obtained from the subjects to participate in the study. Self-structure questionnaire was created odia language. Before STP knowledge was assess by questionnaire. Then Structured Teaching Programme was given by investigator and again knowledge assess by questionnaire.

RESULTS:

SECTION A:

Findings related to Socio Demographic characteristics:

Result shows that maximum of the care givers of post-partum depression 24 (40%) were in the age group 18-28 years, 18 (30%) were in the age group 28-38 years and above 38 years. In that (80%) were Hinduism, (11.67%) Islam and minimum of (8.33%) belongs to the Christian. The graduate and above comprised of 35% care givers, higher secondary and secondary is 36.67% where as 28.33% care givers are primary education. Maximum sample were in the NVD (55%) and the minimum 2 (3.33%) of abortion. Majority of care giver of primi mother 30 (50%) of were joint family, and minimum 2 (3.33%) of them were extended family. Sex of the baby is female 32 (53.33%) and male 28 (46.67%). Monthly family income 21(35%) of ≤10,000 and>20000 and minimum were having 18 (30%) of 10,001-20000.

Table No 1: Demographic profile of Care Givers of Primi Mothers (n=60)

Variable	Classification	Frequency	Percentage (%)
Age (In Years)	18-28	24	40
	28-38	18	30
	Above 38	18	30
Religion	Hinduism	48	80
	Islam	7	11.67
	Christian	5	8.33
Education Qualification	Graduate and above Post graduate	21	35
	Higher Secondary and Secondary	22	36.67
	Primary	17	28.33
Mode of Delivery	LSCS	25	41.67
	NVD	33	55
	Abortion	2	3.33
Family Type	Nuclear	28	46.67
	Joint	30	50
	Extended	2	2
Gender of Baby	Male	28	46.67
Gender of Baby	Female	32	53.33
Monthly family income	≤10,000	21	35
	10,001-20000	18	30
	>20000	21	35

SECTION B:

Findings related to Knowledge of mothers regarding prevention measures of post-partum depression.

PRE-TEST

Level of knowledge	Score criteria	Frequency	Percentage (%)	Mean skill score	Mean (%)	S.D
Adequate knowledge	>75%	0	0	9.33	15.55	1.776
Moderate knowledge	51-75%	14	23.33%
Inadequate knowledge	<50%	46	76.67%

POST-TEST

Level of Knowledge	Score Criteria	Frequency	Percentage	Mean Skill Score	Mean (%)	S.D
Adequate knowledge	>75%	58	96.67%	16.65	27.75	2.262
Moderate knowledge	51-75%	2	3.33%
Inadequate knowledge	<50%	0	0

SECTION C:

Findings related to significant difference between mean pre-test and post-test knowledge score

	mean score	Mean Difference	SD Difference
PRE TEST	9.33	7.33	0.486
POST TEST	16.65	7.33

Data presented in the above table shows that the mean post-test score (16.65) was higher than the mean pre-test knowledge score (9.33). It can be inferred that planned teaching program was highly effective in improving the knowledge score of care giver of primigravida mothers.

DISCUSSION:

Present study shows that majority of participant (40%) were in the age group of 18-28 years of age group in that (80%) were Hinduism. 35% care givers graduated and 36.67 higher secondary and secondary that shows care givers had good educational background. 50% and 46.67% care givers belong from Joint and Nuclear family that shows good social relationship.

In pre-test knowledge, care givers of primigravida mothers had inadequate knowledge (76.67%) and mean skill score 9.33 after STP (96.67%) care givers had adequate knowledge regarding PPD and mean skill score 16.65. It shows that after giving STP on PPD care givers gain adequate knowledge. It helps them to take care of their family member in future. Pre-test and post-test mean difference 7.33 it help us to conclude that STP was highly effective in improving the knowledge of care givers of primigravida mothers.

CONCLUSION:

After the detail analysis the study lead to the following conclusion postpartum depression don’t have 100% knowledge regarding the preventive measure of post-partum depression. The pre-test questionnaires is applied mean skill score is 9.33, maximum knowledge is inadequate (76.67%) and minimum knowledge is moderate knowledge 23.33%. The post-test questionnaires is applied mean skill score is 16.65, maximum knowledge is adequate knowledge (96.67%), and minimum knowledge is moderate knowledge (3.33%).

RECOMMENDATION:

1) The aim study could be undertaken with larger samples to show strong statistical association.

2) A study may be conducted to evaluate the knowledge of preventive measure of postpartum depression.

REFERENCES:

1. Rai S, Pathak A, Sharma I. Postpartum psychiatric disorders: Early diagnosis and management. Ind J Psychiatry. 2015 Jul: 57(Suppl 2): S216-S221.

2. Postpartum Depression. WebMd. https:// www.webmd.com/depression/guide/postpartum-depression#1

3. Stewart D E, Robertson E, Dennis C L, Grace S L, Wallington T. Postpartum Depression: Literature review of risk factors and interventions. University Health Network. https://www.who.int/mental_health/prevention/suicide/lit_review_postpartum_depression.pdf

4. Upadhyay R P, Chowdhury R, Salehi A, Sarkar K, Singh S K, Sinha B, et al. Postpartum depression in India: a systematic review and meta-analysis. Bulletin of the World Health Organization. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5689195/#R1

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6. Beck CT. A meta-analysis of predictors of postpartum depression. Nurs Res. 1996 Sep-Oct;45(5): 297-303.

7. Dennis CL, Hodnett E. Psychosocial and psychological interventions for treating postpartum depression. Cochrane Database Syst Rev. 2007 Oct 17; (4)

8. Polit F, Hungler P. Nursing Research. 6^th ed. Philadelphia: Lippincott company; 1999. P. 201-3.

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Received on 19.01.2021 Modified on 10.02.2021

Asian J. Nursing Education and Research. 2021; 11(3):329-332.

DOI: 10.52711/2349-2996.2021.00079